Provider Demographics
NPI:1932335734
Name:CIRUGIA AMBULATORIA PROFESSIONAL HOSPITAL
Entity Type:Organization
Organization Name:CIRUGIA AMBULATORIA PROFESSIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT BOARD OF DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-884-0505
Mailing Address - Street 1:PO BOX 2698
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-2698
Mailing Address - Country:US
Mailing Address - Phone:787-884-0505
Mailing Address - Fax:787-884-0510
Practice Address - Street 1:STREET # 2 NO 46
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0000
Practice Address - Country:US
Practice Address - Phone:787-884-0505
Practice Address - Fax:787-884-0510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10B1334261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10B1334OtherDEPARTMENT OF HEALTH OF PR
PR40C0001021Medicare Oscar/Certification